Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Pirker-Fruehauf, UM.
OSTEOPOROSIS ¿ A LATE EFFECT AFTER CHEMOTHERAPY FOR BONE SARCOMA
[ Diplomarbeit ] Medical University of Graz; 2011.pp.86
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
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- Abstract:
- High-dose methotrexate, a standard agent in the therapy protocols for osteosarcoma, has long been suspected to have a negative long-term effect on bone metabolism and bone mineral density (BMD), especially in children and young adults. Recent literature questioned this association as also the BMD of Ewing's sarcoma patients treated without methotrexate is known to be decreased. We therefore wanted to evaluate the skeletal status of our patients concerning bone loss and laboratory alterations as well as skeletal related events like osteopenia-/ osteoporosis-associated fractures after chemotherapeutic treatment. Our series of measurements included 43 patients ¿ 18 Ewing´s sarcoma, ten male and eight female, with a mean age of 26 years ± 7.61 SD (12 to 44), and 25 osteosarcoma, 16 male and nine female, with a mean age of 27 years ± 10.34 SD (7 to 49). The mean time between diagnosis and investigation was 8 years (± 4.17 SD) in Ewing´s sarcoma and 7 years (± 4.73 SD) in osteosarcoma. We were using dual-energy x-ray absorptiometry (DEXA) for measuring bone mineral density in the femur and the lumbar spine in addition to laboratory examinations and a lifestyle questionnaire. Referring to the age and gender matched Z-score we found a reduction in BMD in 58% (37% osteopenia, 21% osteoporosis) of our study participants in at least one of the measured localisations (lumbar spine or femur). Additionally in two Ewing´s sarcoma (2/18) and five osteosarcoma patients (5/25) non-trauma-associated fractures occurred after chemotherapeutic treatment localised in the proximal femur 30 and 72 months after tumour diagnosis, the distal femur after 29 and 72 months, the proximal tibia after 29, 32 and 192 months and digital after 36 months (one Ewing´s sarcoma patient suffered from fractures affecting both ¿ the distal femur and the proximal tibia). Concerning laboratory our patients presented numerous dysbalances in bone metabolism combined with a vitamin D deficiency in 88% and a genetic predisposition for lactose intolerance in 37%. Densitometry results as well as laboratory findings did not significantly vary between Ewing´s ¿ sarcoma and osteosarcoma patients although the Ewing´s sarcoma group tended to show lower bone mineral contents. Our results indicate that a reduction in bone mineral density in young childhood cancer survivors presents a possible threat not only in osteosarcoma patients treated with high-dose methotrexate, but also in patients with Ewing´s sarcoma. Young patients undergoing cancer treatment experience long time of hospitalisation, possible lack in nourishment due to chemotherapeutic nausea and contrary to healthy people of the same age are partially forced to inactivity in a life period of high importance for gaining their genetically programmed peak bone mass. When all this is cumulating with seasonal or permanent vitamin D insufficiency/deficiency in combination with calcium malnutrition plus a possible genetic determination for lactose intolerance it might potentiate the direct and indirect bone harming effects of cancer therapy on the skeletal system. Therefore preventive after-care treatment of childhood cancer survivors should be part of a sensitive patients´ management. Densitometry combined with laboratory examinations can provide us with easily achieved and patient sensitive information which does not only detect deficiencies in bone mineral density, but also gives important clinical information about the possible causes. Supporting young childhood cancer survivors with sufficient vitam ...